Radiofrequency ablation for the treatment of wolff-parkinson-white syndrome: experience in 1,239 cases

Abstract Background Wolff-Parkinson-White (WPW) syndrome is a cardiac rhythm disorder characterized by the presence of an abnormal pathway connecting the atria and ventricles, which can cause supraventricular tachycardias, syncope, and, in rare cases, sudden death in a subset of patients. The definitive and well-established treatment is catheter-based radiofrequency ablation. Objective To present the outcomes of radiofrequency ablation in 1,239 patients with WPW over 26 years in our invasive electrophysiology service. Materials and Methods From January 1998 to April 2024, 7,737 electrophysiological studies were conducted in our center, with 3,718 involving radiofrequency ablation. Among these, 1,239 patients (33.3%) had ventricular pre-excitation (WPW). Patients were routinely taken to the electrophysiology lab, sedated if adults, or under general anesthesia if younger than 10 years. Local anesthesia was administered, followed by femoral venous and/or arterial punctures, and in some cases, radial access. Catheters were positioned in the tricuspid or mitral rings for ablation. Radiofrequency energy ranged from 50 to 55 watts, with temperatures of 55-60°C and durations of 60 to 180 seconds. Post-ablation tests included atrial and ventricular stimulation, intravenous adenosine infusion, catheter removal, local dressing, and hospital discharge after 24 hours. Results In this analyzed group, ages ranged from 3 to 86 years, with an average of 31.5 years; 676 patients (54.5%) were male. Successful ablation was achieved in 1,167 cases (94.2%). Four patients (0.32%) experienced complete atrioventricular block as a complication, with no cases of tamponade. There were three cases of pseudoaneurysm (0.24%), and four patients (0.32%) had WPW associated with structural heart disease (Ebstein’s anomaly). Sustained atrioventricular tachycardia episodes were induced in 780 patients (63%) during electrophysiological studies. Focal cryoablation was used in eight patients (0.64%) with parahisian pathways. Multiple abnormal pathways were found in 22 patients (1.77%). Accessory pathway locations were as follows: left posteroseptal (175 patients, 14.12%), right posteroseptal (241 patients, 19.45%), right anteroseptal (99 patients, 7.99%), right lateral (191 patients, 15.41%), left lateral (272 patients, 21.96%), right mid-septal (176 patients, 14.2%), anteroseptal (20 patients, 1.62%), and parahisian (65 patients, 5.25%). In 32 cases (2.58%), it was not possible to eliminate the abnormal pathway during the procedure, and 30 patients (2.42%) experienced recurrence of ventricular pre-excitation during follow-up, undergoing a second intervention. Conclusion Catheter-based radiofrequency ablation for definitive treatment of ventricular pre-excitation (WPW) has proven to be a well-established technique with very low complication rates, even in patients with structural heart disease or in pediatric populations, achieving complete symptom resolution.